Why does IQWiG work in accordance with the principles of evidence-based medicine (EBM)?
Evidence-based medicine (EBM) is an important basis of the Institute's work. It denotes health care that is not based solely on personal opinions and conventions, but on proof (evidence). This proof should be obtained using the most objective scientific methods possible and provide reliable results.
EBM in practice
In practice, this means that doctors do not rely solely on individual practical experience, but also consider the results of current scientific research in their therapy recommendations.
A question is first derived from the current case. This question then forms the basis for the search of the medical literature. If relevant studies and articles are found, the results then have to be assessed for their reliability. In combination with the doctor's experience, a therapy tailored to the individual patient can then be created, based on the best possible knowledge.
IQWiG follows a similar procedure. However, the research question is not triggered by an individual patient, but by the question whether a medical intervention is reimbursed by the statutory health insurance funds. Nevertheless, the Institute also formulates a scientific research question first and then performs a systematic search of international scientific literature for scientific proof (evidence) of the benefit of the intervention.
Why does IQWiG use EBM?
The aim of evidence-based medicine is:
- to provide answers to medical questions, such as whether one treatment has more benefit than another, in a structured and systematic way.
- to provide high reliability of results for decision-making. A standard element of EBM is to carry out a systematic search and synthesis of all studies of appropriate quality on a question. This summarizes the current state of knowledge.
- to guard against wrong decisions and false expectations. For example, by avoiding situations where beneficial treatments are not included in the provision of health care or where non-beneficial treatments can harm patients.
All these aspects are important to IQWiG. The Institute's reports are often the basis of policy decisions by the Federal Joint Committee (G-BA). This means that IQWiG's recommendations must be scientifically reliable.
Evidence-based medicine allows an assessment of how reliable the available knowledge on an examination and treatment method really is. Furthermore, it allows an assessment of where reliable data are missing. This aspect is often just as important in the provision of health care because only when gaps in knowledge are discovered, can targeted research be conducted in these areas.
How is a benefit assessment conducted according to EBM criteria?
In general, an evidence-based benefit assessment in health care involves the following steps:
- Formulation of the research question using the PICO formula: patient, intervention, comparison, outcome
- Search of the medical literature
- Extraction and evaluation of information. This includes describing the methods and results of the studies identified in the literature search, and undertaking a methodological assessment of the reliability of results and the transferability to the actual healthcare context.
- Synthesis and final evaluation of all documents considered
These steps are always carried out systematically and are therefore reproducible.